Provider Demographics
NPI:1942341698
Name:BURKS, JAMES D JR (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:BURKS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11222 W US HIGHWAY 136
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46147-9587
Mailing Address - Country:US
Mailing Address - Phone:317-852-5500
Mailing Address - Fax:317-852-5588
Practice Address - Street 1:910 N GREEN ST
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1033
Practice Address - Country:US
Practice Address - Phone:317-852-5500
Practice Address - Fax:317-852-5588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001245A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100185760AMedicaid
IN20-5016740OtherSOLE PROP. TIN
IN35-1845727OtherPRIOR CORPORATION TIN
IN35-1845727OtherPRIOR CORPORATION TIN